Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 4301117274 | MI |
N | 208000000X | Pediatrician | 125.069563 | IL |
NPI | 1750732590 |
---|---|
Provider Name | Dr. Stephanie Campbell |
First Address | Detroit, MI 48207-4997 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 08/07/2019 |